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Products & Services Managed Care Patient-Centered Managed Care

Meeting the Challenge of Copay Accumulator Programs: Effective Pharma Strategies & Tactics for Ensuring Patient Access

ID: PSM-359


Features:

24 Info Graphics

35 Data Graphics

770+ Metrics

63 Narratives


Pages: 70


Published: 2019


Delivery Format: Shipped


 

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919-403-0251

  • STUDY OVERVIEW
  • BENCHMARK CLASS
  • STUDY SNAPSHOT
  • KEY FINDINGS
  • VIEW TOC AND LIST OF EXHIBITS
The introduction of copay accumulator programs has significantly increased the out-of-pocket (OOP) costs for patients, posing an existential threat to certain prescription specialty treatments.

Specialty pharma manufacturers are taking rapid steps to ensure both patient access to medicine and ongoing adherence by developing a comprehensive copay accumulator mitigation strategy that meets the full scope of the threat.

Best Practices, LLC undertook benchmarking research to determine the impact of payer-imposed copay accumulator programs on specialty pharma manufacturers and their patients. This research examines the most effective tactics and strategies employed by organizations for mitigating the impact of copay accumulator programs.

This report will provide market access and reimbursement leaders with critical benchmarks and insights around: copay accumulator threat assessment, leading and lagging indicators of copay accumulator impact, decision triggers to
counteract copay accumulators, effective copay accumulator mitigation strategies and tactics, use of new forms of copayment, types of non-coupon copayment approaches, financial assistance outlays, and key performance indicators to measure the effectiveness of copay accumulator mitigation strategies.

This report also highlights the operational hurdles, success factors and lessons learned in implementing an effective copay accumulator mitigation strategy.

Industries Profiled:
Biopharmaceutical; Pharmaceutical


Companies Profiled:
Specialty Biopharma Companies

Study Snapshot

Best Practices, LLC engaged 25 Market Access and Patient Support executives from 21 specialty biopharma companies in this research through a benchmarking survey. In-depth interviews were conducted with 9 benchmark partners to gain further insights. Almost 90% of the benchmark partners serve at the director level or above.

Insights in this research are presented in two segments:

  • Total Benchmark Class: Data based on survey responses originating from all 25 manufacturers in this study (abbreviated as “TBC”)
  • Out-of-Pocket (OOP) Costs Minimizers: Data based on survey responses from 7 manufacturers who have reported success in minimizing patient OOP costs, the top-rated objective of copay accumulator mitigation strategies across the industry.

Key topics covered in this report include:

  • Copay accumulator threat assessment
  • Key market triggers and decision points considered for counteracting copay accumulator threats
  • Copay accumulator mitigation tactics and strategies
  • Financial assistance as a percentage of overall product revenue
  • Copay accumulator mitigation strategy KPIs
  • Challenges and key lessons learned in implementing copay accumulator mitigation strategy
  • Best practices and lessons learned in ensuring a positive patient experience
  • Future market access challenges and potential mitigation tactics


Key Findings

Select key insights uncovered from this report are noted below. Detailed findings are available in the full report.

  • All indicators show widespread negative impact: Across the specialty world, the negative effects of copay accumulators are glaring for pharma and patients alike.
    • Among companies who track leading indicators, up to 94% have measured increases in out-of-pocket costs (OOPC), number of patients impacted, field complaints, patient complaints and abandonment rate. Most manufacturers have seen 1-10% increases in OOPC, abandonment and complaints. One-fifth of respondents have measured OOPC growth in the 11-30% range.

  • Building an effective copay accumulator mitigation response team: Internal copay accumulator Task Forces should include the perspective of finance, government affairs, legal and patient support partners.
    • Besides market access groups (who serve on 100% of copay accumulator mitigation teams), roughly 50-60% of benchmark companies also tap patient services, brand, and market analytics teams to develop and execute a complete copay accumulator mitigation strategy.
    • Internal Task Forces should strongly consider partnering with legal, government affairs and patient advocacy colleagues, who are vital to helping plan and executive patient support strategies which can overcome complex OOPC hurdles. Most companies with a good track record in controlling OOPC have incorporated some or all of these functions into the copay accumulator mitigation strategy process. Such companies also report greater effectiveness in driving external policy initiatives, advocacy and employer outreach, and even some payer interactions.

  • KPIs used: The most prevalent copay accumulator mitigation strategy KPIs include: # of patients impacted, OOPC and adherence rate metrics.
    • Despite tracking a wide number of indicators of copay accumulator fallout on patients and the business, benchmark manufacturers focus on a relatively small number of KPIs to measure and drive their mitigation strategy. The number of patients impacted is most widely used (75% of companies), followed by OOPC (67%) and adherence rate (54%).
Table of Contents

I.
Executive Summary
Research Overviewpg. 3
Key Findingspg. 6
II.
Full Study Data
Quantifying the Copay Accumulator Threatpg. 12
Key Indicators of Copay Accumulator Impact on Specialty Productspg. 19
Copay Accumulator Mitigation Program: Strategy & Tactics Usedpg. 28
Evaluating Operational Challenges, Program Success, and Lessons Learnedpg. 50
Creating a Seamless Patient Experiencepg. 58
Future Threats and Market Access Challengespg. 64
III.
About Best Practices, LLCpg. 70

    List of Charts & Exhibits

    I. Quantifying the Copay Accumulator Threat

    • Characterizing the severity of the threat posed by copay accumulator programs (and related programs like copay maximizers) to benchmarked organizations and the pharmaceutical manufacturing industry on the whole
    • Success rating of benchmarked companies’ copay accumulator mitigation strategy thus far
    • Leading and lagging indicators of copay accumulators
    • Average percentage of specialty products currently affected by copay accumulators
    • Approximate percentage of total commercial channel product volume subjected to co-pay accumulator programs
    • Market access leaders’ approach toward altering their copay accumulator mitigation strategies as legislative developments come into effect from Jan. 1, 2020

    II. Key Indicators of Copay Accumulator Impact on Specialty Products

    • Leading indicators of copay accumulator impact and trigger for taking action
    • Lagging indicators of accumulator-driven brand erosion
    • Importance of listed factors in convincing organizational leadership of the need to take action to counteract copay accumulators – Total benchmark class
    • Importance of listed factors in convincing organizational leadership of the need to take action to counteract copay accumulators – OOPC minimizers and Manufacturers with no OOPC progress
    • Voices from the field: Single-most critical factor for implementing copay accumulator mitigation strategy

    III. Copay Accumulator Mitigation Program: Strategy & Tactics Used

    • Importance of each of the listed objectives in the organization’s strategy for mitigating the impact of copay accumulator programs
    • Effective tactics for countering copay accumulators on both macro and micro levels
    • Effectiveness of each of the listed steps for mitigating the negative effects of copay accumulator programs
    • Extent to which benchmarked organizations have observed harmful inflation in each of the listed areas as a result of copay accumulator programs – For companies using prepaid debit cards
    • Cons and risks of using prepaid debit cards, benchmark usage data
    • Effectiveness of copay accumulator mitigation tactics
    • Extent to which benchmarked organizations have observed harmful inflation in each of the listed areas as a result of copay accumulator programs – For companies planning to use prepaid debit cards
    • Extent to which benchmarked organizations have observed harmful inflation in each of the listed areas as a result of copay accumulator programs – For companies not using prepaid debit cards
    • Use of new forms of copayment
    • Types of non-coupon copayment approaches
    • Percentage of total product revenue allocated by benchmarked organizations to all forms of financial assistance currently
    • Percentage of total product revenue allocated by benchmarked organizations to financial assistance immediately prior to the existence of copay accumulators
    • Average increase in financial assistance outlays - OOPC minimizers vs. Manufacturers with no OOPC progress
    • Interview narrative around the approach to tackle the challenge of growing financial assistance costs
    • Interview narrative around copay vendor support
    • Additional copay accumulator mitigation tactics or activities conducted by benchmarked organizations
    • Main discussion points and outcomes of direct payer interactions for organizations that directly meet payer groups to address access-to-care challenges or negotiate new payment terms related to copay accumulator programs
    • Internal functions actively involved in molding strategy and executing activities to counteract copay accumulator programs – Total benchmark class
    • Internal functions actively involved in molding strategy and executing activities to counteract copay accumulator programs – OOPC minimizers and Manufacturers with no OOPC progress
    • Copay accumulator mitigation tactics - Total benchmark class vs. Expanded copay accumulator response team

    IV. Evaluating Operational Challenges, Program Success, and Lessons Learned

    • Metrics used to measure the overall performance of copay accumulator mitigation strategy
    • Impact of copay accumulator mitigation efforts on the listed key areas
    • Difficulties in overcoming the listed operational hurdles in implementing copay accumulator mitigation strategy – Total benchmark class
    • Difficulties in overcoming the listed operational hurdles in implementing copay accumulator mitigation strategy – OOPC minimizers and Manufacturers with no OOPC progress
    • Voices from the field: Incorporating inputs from copay vendors into copay accumulator mitigation strategy
    • Success stories of companies that have combatted copay accumulator programs
    • Most important lessons learned in launching efforts to mitigate the effects of copay accumulators

    V. Creating a Seamless Patient Experience

    • Effective tactics for supporting patients who face treatment disruption as a result of copay accumulator
    • Case example of a real-time benefit investigation model developed by one innovative specialty manufacturer to determine optimal prescription payment & distribution model
    • Voices from the field: Strong existing patient support hubs are well-positioned to meet new challenges such as copay accumulators
    • Interview narrative around white-glove service within the patient support hub
    • Top lessons learned in ensuring a positive patient experience despite changes in how their treatment is financed

    VI. Future Threats and Market Access Challenges

    • Characterizing the threat posed by copay accumulator programs to the individual pharma organization and the pharmaceutical industry on the whole
    • Likelihood of new payer / PBM payment policies circumventing pharma manufacturer’s copay accumulator mitigation strategy
    • Interview narrative around payer negotiations
    • Optimal path for resolving copay accumulator issues
    • New payer strategies and tactics, besides copay accumulator mitigation activities, likely to negatively impact patients / manufacturers; potential mitigation tactics for these new payer strategies